 Now, without much ado, we will continue on to the presentation of the day, our presentation on how the social media influenced backing choices. Our presentation today will be presented by Antonin Paziani and Sophia Day. They are both students and before they make their presentation, a little bit more about both of them. Antonin is a third year student midwife at Western Sydney University. In her former life, she was a public relations and events manager working with tourism and lifestyle brands from around the world. All the glamour of media land kept her busy deep down. Antonin has always wanted to be a midwife. Finally, answering the call to begin her degree in 2018, as a trained yoga teacher, her interests reside in the connection between body and mind and particularly how this plays out during pregnancy, birth and young. This year, Antonin will put her studies on hold to complete her degree in 2021 as she prefers to welcome the arrival of her first child in June. Her co-presenter, Sophia Day, is in her final year of studying a bachelor of midwifery at Western Sydney University. Sophia has been assisting as a volunteer with a research project at her placement hospital. Her contribution has been in data entry, exploring how midwives proceed new graduates. Sophia also has a bachelor's of communication, media and journalism and hopes to utilise her skills in future research endeavours. Her future interests lies in understanding international models of women-centred care and hopes to contribute to Australia providing gold standard care. Without much ado, I'd like to welcome Antonin. Continue with the presentation. Thank you. Welcome, Antonin. Thank you very much, Carol. That's a really nice introduction and hello, everybody. Welcome to our presentation today and happy international day of the midwife to everyone. Current midwives and future midwives. I think you're a few in here as well, which is also great to see. So, yeah, as Carol said, our presentation is about social media influencing birth and choices. And I guess a bit if you can hear a bit of our background. We've both studied media and we've also worked in the media both recently and in the past. So, to answer the question about why this area is of interest to us, I guess it's something that used to, it is part of our professional life and something that we've seen evolve over the last decade and now we're looking at it from a different perspective as well. Sophie, I didn't know if you had any to add to that. Hi, everyone, and welcome. It's so great to see so many people across the world. Thank you, Carol, for that lovely introduction as well. So, to follow on from what Antonin has said, I think as students, naturally, we kind of gravitate to Instagram as another form of education. And I know I certainly have and I've seen amazing things that I haven't yet seen in hospital and I think it's really opened my eyes up to a different community. And I think we've done this in our studies and joined our own community there. And so, I think here we wanted to explore Instagram specifically and how it has influenced women's perceptions of birth. So, we've selected a handful of images to go through and also done a small survey among our cohort just to ask them what they thought of the images. And we really encourage you all to engage with the images and to let us know what you think of them as professionals or members of the public or educators and researchers. So, that brings us to some of the research that we did into social media and just understanding what's the conversation, what's the narrative around social media these days. So, two of those studies that really kind of stood out to us was birth images on Instagram, the disruptive visuality of birthing bodies and sharing special birth stories and exploitive study of online childbirth narratives. So, Fifi is going to take us through the first one. So, can you give us a bit of a background about this study and what was so significant about it? Yeah, so, maybe many of you midwives would not know what it was, an Instagram account called Empowered Birth Project. And this was led by Katie Vigos, who was a registered nurse and doler. And she had a beautiful Instagram page and shared just these births that she was experiencing. And Instagram said that it was no longer appropriate because of the full frontal nudity, the close-ups of vulvas and breasts and bodily fluids, and it deemed that it was pornographic and too offensive. And so, they began censoring these images and shut down a lot of them and took them down. And this created a little bit of an uproar among Instagram users and it sparked her to create a change.org campaign, petitioning for Instagram to revise its censorship policy. And they got over 20,000 signatures and that was enough to lift the ban in 2018. And I guess it got a lot of people talking about why this was done, why censor these images that's, you know, the human body, you know, in its natural form link that is, you know, half the population do. And it really started a conversation and I think, you know, they've created so many more Instagram pages that attribute to birth and what it's all about. And it's about normalizing it and you're not just hearing stories of people's experiences and sometimes you need to see it to believe it. And so, a lot of people have created Instagram accounts based around that that are now open to public. So, that's what the study was really about and what was the meaning behind the censorship and what did it do for public users. Yeah. And I guess because we're looking at social media specifically, can we make a difference? Is there a difference between popular media, you know, our normal broadcast TV style images and things like that to social media? Yeah, absolutely. I think traditionally in films or TV shows, we see images of women in in stirrups all gowned with hair and makeup and an obstetrician attending to her, which is in stark contrast to the reality of birth, which is rarely glamorous. TV and films tend to instill a sense of fear by always reporting the pain of childbirth. And whereas these images on Instagram really challenge what we've seen on TV and film and illustrate that, you know, it really is quite a glorious mess. And I think women often, while they're in a pushing stage, wonder, you know, did I, excuse my profanity, but did I just shit myself? And they, you know, they apologize for it. And, you know, as midwives, that is a wonderful sign of progression. And, you know, she doesn't phrase that's one bit and can be distinguished. And I think for women to maybe see some of these images of videos of other female bodies in the same position helps to normalize and prevent that self-consciousness. And I think you have seen how artists have done it. They've painted and exhibited images of vulvas, which I think will help like help a lot of women of all ages to understand the female anatomy in a way that we've really never seen before and have never had so much access to as something like Instagram. So, like, I guess there's an element, definitely, of feminist discourse or something here, because we're talking about female bodies in display and we're talking about, you know, people's responses in terms of like almost outrage at what they're saying. Yeah, absolutely. I mean, when Instagram decided to censor these birthing images, deeming them offensive, I think it gave the impression that female bodies should only be presented in certain ways and that a birthing body should be hidden. And I think that's that strips a lot of women of form of empowerment and denies them the opportunity to feel united and also in solidarity with other women who have shared their birthing stories online. And I guess this could be seen as a form of oppression. And that's what this so does explore. And it also takes me back to my point earlier about, you know, this perceived perfect body. We've seen previously how corn has, you know, been responsible for digitally enhancing women's, you know, on-screen volvers to the degree that we're seeing an increase in demand for female genetic genital cosmetry. But in fact, nothing is clinically wrong with their volvers. And I think it comes down to this idea of perception and the images that we see on Instagram accounts like Australian birth stories or birth becomes her old badass mother birther that they illustrate so much diversity in women's bodies and their births, which is incredibly empowering. And I think that creates a community when our physical communities, I mean, especially now during COVID, you know, they're extremely limited. And so we can really come together on this platform. And that's really great for women to be able to do so. And in this article, the author refers to the second wave of feminism, which in the 70s, the feminist women health centres asked women to self-examine their body and get into touch with it and feel in control and informed. And surprisingly, British survey looking at female knowledge of their anatomy found that 60% of women still cannot identify their volvers on a diagram. So I do believe that, you know, by censoring those images kind of takes that power away from women that, you know, their bodies are magnificent. And, you know, it's great that we can own that and share that among the world. I think that's really powerful. And I guess it's definitely something that culturally will will, I guess, make sense in different contexts as well. So we're mostly talking about in a Western context and things like that. But we totally understand that, you know, different countries in different places will celebrate bodies in different ways. Do you think then that, you know, we have these amazing progressions in social media that there is an element of helping, but there is also an element of, you know, is it dangerous? Is there an element of danger or something that we need to be aware of when we are so freely sharing images like this? Yeah, absolutely. I think you always see some of these comments on these Instagram images that we're going to share that some of the comments are I've never seen. And, you know, it also then allows women to kind of see to believe what's possible and to ask more questions of their midwives or health care providers or obstetricians, whoever it may be to kind of get that discussion going of, you know, how would I like my birth to be? But the flip side to that is that every single woman's body and her pregnancy and her labor are different. And I think that there is a danger that women can see these images and expect their birth to go a certain way and then become disappointed when it doesn't. And I think then it's important that women understand that they do have a choice in everything about their pregnancy. But I suppose some women may develop complicated features of their pregnancy that may not be what they've seen through Instagram and therefore, you know, feel that they're disappointed that they can't have that experience as well. So, yeah, I do believe that there's also then a danger of sharing these images down side to it. However, I still believe that, you know, knowledge is power and to be able to see these images is another form of education and understanding in a community that otherwise they may not have been privy to before. Nice. Yeah, I think it's it's a study that really shows how powerful images can be, but also how powerful community can be online to mobilize like a cause really quickly as well. Yeah. So, Antoinette, can you tell me a little bit about your research that you looked into published by Women and Birth about sharing special birth stories and explorative study of online child birth narratives? Yeah, so this study was done in the Netherlands. And I know we've got a couple of people from the Netherlands here, which is lovely. So this study looked at and it's a bit closer to, I guess, the theme of our presentation today in looking at how women create narratives around their birth stories, but but also use birth stories as part of their decision making in their own births. And I guess the the pain point or I guess the intersection of that is how does when that meets midwifery care or, you know, obstetric care, how do we meet women on that journey to be able to work with them to kind of you know, how do we care for them based on what they've seen and what they've heard out there in the community. So what were the kind of main points of the research study? So there are a few. So being a qualitative study, there were quite a few seeds that came out of this. And the first thing is that there are lots of different types of narratives that women construct when they're sharing their stories on social media. So there's sharing your story and figuring out whether or not it is worth sharing your story in exchange for the stories that you got to help you going into detail and how much you go into detail about your birth and then doing it yourself. So talking about the preparation that came with pregnancy and birth, but also what you didn't do. So if you didn't take advice from your midwife or your health care professional and sharing whether or not that happened. So there are three kind of narratives, which I don't think are, you know, quite different to how we normally speak, you know, to each other, but these were definitely more measurable in terms of how you could see these play out on social media. Another key learning from this is that birth stories are always going to be told and they've been told forever and ever. This is just a new way that we're seeing this happen. And as you said, during the time where we are quite isolated, we're probably sharing even more because we're reaching out to each other to create communities where we can't physically do those at the moment. But they aren't always intended for recommendations or advice. They're just ways of helping us identify with people who, you know, whose behaviors, whose values, whose beliefs that we might align ourselves with and, you know, a path that we might like to go along in terms of what we see as, you know, birthing women or, you know, as midwives, you know, playing out in our pregnancies and births. There was a key thing in this where I'm not sure the girls from the ladies from the Netherlands can maybe let us know in the chat, but they did make a point that just given the structure, the healthcare structure in the Netherlands, some of the midwives, some midwives actually discourage people from using social media and using outside sources and encourage them from using, you know, stuff from the healthcare provider because whether it was just a sense of control or the fact that, you know, they, you know, there was more trustworthy coming from a body of evidence as well. But I think the key learning from that is that that's pretty futile effort because the internet is such a big place for us to get information and share with each other. And then finally, it raises the questions about consequences of birth stories, which you've touched on. So, you know, how does it influence your decision about where, how, what pain relief you use, what ideas you have about breastfeeding and postnatal care and things like that. So, you know, how do these have a role on effect to everybody else? Yeah, right. OK. And this is a bit of a side question, Antoinette, but as a student midwife and also a pregnant woman, how do you kind of drive that world of, you know, being so in the know and then do you access Instagram yourself and kind of take ideas of what you may like for yourself or where do you sit? Yeah, it's it's an interesting place to sit. I think just as a student midwife, we sit in a really advantageous place because we're able to stop, reflect, stand back and have a look at, you know, what practice, what's going on. But we also have that little bit of extra time that we can maybe speak to our women and understand them a little bit more than sometimes what our midwives have time to do, especially if we work in a big hospital system as a pregnant woman. Yeah, that one's an interesting one. Just struggling both of those because sometimes you just have to remember that you're a pregnant woman first and you're a midwife second. And so you really need to tune into your own personal things in that sense. So, yeah, you kind of toggle between both at this stage. So be interested for the midwives and the mums here as well, if they have anything to share about that, too. Yeah. So just lastly on this one, I just wanted to say before we launch into the images that I did basically the research that we found really adds to the conversation about, you know, how social media contributes to culture and community. And having been in, you know, working in the media and working with brands and things like that, you know, I've seen social media be the other and the outside thing and how do we make it, you know, how do we incorporate it together and there's a lot of work to be done around that. So I think it's a really important time to be talking about it because I think we're at that point now where, you know, midwifery and social media and how we share birth stories is coming to a point where we can meet and we can make it a really powerful tool for everyone. So without further ado, we have a range of images. So these images came, we also put into a survey, which we asked a whole bunch of people, you know, in our community, what they thought, basically first impressions, but also as you start to take in the images and maybe read the captions, start to understand a bit of background about or have questions. So if you would prefer to type your question, please feel free if your fingers don't work as fast as your brain, you can raise your hand and I think Carol will unmute you or something and we can answer your question verbally. That's that's totally fine with us. So what I'm going to do firstly, just so that you can see is pop the links to all of these images in the shared notes. And that way you can work through them and have a look at them on your own devices, because you may be able to have a look at the comments a little bit more. But as you can see, we've got our first one here, which is quite a big one. So, yeah, there's a bit of context for this one if you want to take us through it. Yeah, so as you can see, if you can, there is this is a bridge home birth. Um, it's in the water in the water, there's a lot going on here. And I think there are so many things that you pick up on. You see that there's the use of a rebozo, which is including the husband. You can see a bit of acupressure being performed by the midwife. There's a bath free relaxation. There's beautiful dim lighting in a bedroom, which is an environment where the woman obviously feels that that's where she's most comfortable in. But I just think, you know, the breach, birth, that home in water. For me, when I saw this, I just thought, how is this possible? So I don't know if anyone else has any comments about, you know, whether they've seen this, you know, in a home birth setting. And to that you have any points of some initial thoughts when you saw this image? Yeah, I think you take in everything else about the image first. All those wonderful things that you said. And then you look in the water and realise that there's lots of arms and legs and no head yet and then you realise what it is. So, yeah, I think it is really striking in so many ways. And then as well, it's kind of, I feel a little bit conflicted by it because I have no background to this at all. So I have no idea what's happened prior to this birth. I have no idea about this woman's, you know, anti-natal care or the choices that she's made. So at first, I might think, God, this is like radical, but really, you know, they could have been a lot of really smart decisions making along the way, which, you know, at the end of the day, I think I could probably support, but I've never been in a breach birth. Does anyone have any comments or anyone know? Yeah, so a lot of people are saying, you know, I want to know the birthing story. I want to know the context of it all. And I think, you know, images can tell a thousand words, but then they can also leave out quite a lot as well. But but the main thing is that, you know, it peaks your interest and, you know, it makes us ask questions about, you know, what is possible? Yeah, and taking to some of the comments from our survey, a few people said I'd never seen a breach birth in real life. And I think, you know, the fact that it's also in a home birth setting and that some people find this quite challenging because associate breach with being fairly risky. And, you know, especially in this home environment, I think a lot of women might not think that this was a possible option for them. And, you know, like you say, Antaneth, you know, depending on her antanatal care and her story that, you know, has gotten her to that position would definitely be taken into consideration. But some of the comments from our survey were, you know, quite in awe that this was possible, but also quite celebratory that she had the supported birth, that maybe that's what she wanted as well. Yeah. Oh, yeah. So this one seems a little bit more familiar, I think, to me, you know, I see a lot of familiar things in terms of, you know, a CTG machine. I can see probably a midwife right there. She's certainly I can see birthing balls in the background. But then there are also a lot of, you know, lovely things as well, like a woman, you know, in a good position, an upright position and catching her own baby. So there's a lot of like meshing of two worlds in here, which is really positive for me. But I think it's mostly because I feel safe in this image. Yeah. And the international people, I mean, you may or may not have heard of Australian birth stories and it's quite a popular podcast in Australia. And this is the host herself with her birth of her third baby. And I think given she's quite influential disaster podcasting, you know, her birth Instagram, you know, could have a lot of influence for women just seeing how she births as well. Yeah, definitely. I think that's another thing and it's something to touch on in another presentation. But, you know, social media influences exist and they have a lot of power and they have a lot of you know, clout, I guess, in their communities. So for someone like Sophie, who has a huge social media following the sense of responsibility that she has in broadcasting these images and broadcasting what choices she makes, I think is huge personally for her. But also is huge just in the wider context of us, you know, you know, making decisions about what we do in birth. I think there's some comments that we had from our survey. Let's have a look at one. One. Hurray, look at this. Obviously, hospital worth of the monitor, but she's in a chosen position and all looks well. Most people think this is a pretty inspiring image. And that the birth shows that what can be achieved, it would help others find that in a goddess in a hospital setting with a monitor. So I think it's kind of saying that, you know, the two worlds can combine and, you know, you can have positive outcomes. You can be smiling afterwards. It's not all doom and going once you walk into the hospital. Yeah, absolutely. And I think what's so great about this podcast and that she's also brought to Instagram is how many positive comments there are and just to the community itself. There's so much support among women who engage with this platform and may also be men as well. But yeah, you don't see too much negativity, which is also lovely to see. Yeah, I like maybe you've made a really good comment there. It's it's not a competition and you're absolutely right. You know, and it is it is what it is. We still have to be open minded about what happens in birth and we can't be trying to top each other with the most outrageous or the most amazing natural births or normal births or anything like that. Everyone's stories is different. So there does have to be a level of acceptability and non-judgment in these platforms, which I think here we've seen some very positive stuff. But I think later we'll see some not so positive stuff. Yeah, and great to see the dad involved in this image to a nice pick up. Tinka. So I'll move on to the next one. So this one, when we share this with our survey, some people are what's happening here. And I think for those who don't know, this is a sterile water injection. And this is a form of non-phonicological relief and can be very effective for women who have posterior labours. And I suppose we wanted to talk about it is because we don't think it's talked about it that much. And a lot of women don't actually know what sterile water injections are because they might not be actually offered to them. I think that someone has already said, I've never seen these in real life. I'm with you, Peter of I. I've heard them offered maybe once, but other than that, no, they've never been taken up. I've heard that they hurt, but the relief is pretty good afterwards. Yeah, and I think some people think it's quite confronting seeing all these needles being put into a woman's back, which is fair enough. But it might get the conversation rolling around options of pain relief for women. Mm hmm. Definitely. I'll move on to the next one. Yeah. Keep talking, your comments, we can always come back to them. Yeah. So I think this one personally working in a tertiary hospital, I think this image we can see a fair bit with women who are commonly induced because it is a more of a higher risk hospital and process of having the CTG and being hooked up to IV being monitored. I mean, looking at it, it seems like an overwhelming image. And you can see that she looks overwhelming as well, overwhelmed. Yeah. And I think the biggest thing going back to our first image, which was so shocking when we all just wanted to know the context that this caption actually gives us a little bit of context as well. So, you know, we can understand why she might have her head in her hands right now. This is a really big moment for her, but still a really powerful moment. And I think as a future midwife or a current midwife, it just for me just draws out that wanting to care and wanting to make this, you know, the best, the best experience as we can, given whatever the situation is. I'm going to review about evidence for water injections. If anyone has any resources, definitely please share or any experience about those. I think that one's just set up for some topics. Some comments from our survey about just the general feelings about it. You know, it's overwhelm, it's anticipation, it's pain. You know, I get the sense that she's frightened, not only for the baby, but for her own health. You know, I feel sad for her. She's restricted and all of that things. So, yeah, this is a really highly emotive image in a different sense for sure. 50 people typing. Yeah, we'll let you guys catch up. Just being their best selves is like you're definitely one day. And I think, you know, that comes in so many different shapes. Yeah. Cool. I think we've got two more images that we can quickly whip through. OK. So this is our home birth shoulder dystocia in the barn. Which I guess there are some risk factors that you can maybe think that a shoulder dystocia in the barn, but, you know, not always, that's for sure. And this is an environment where it looks like, you know, the midwife is in control of it. And there are lots of people working together. But it is also a confronting image. Yeah, absolutely. There's obviously a lot of positives to doing it this way. But yeah, there are, as you said, there are always, always risk factors. So the images are quite shocking. If you've never seen like a birth image before, you may just think that this is kind of the normal way. But as you kind of read through the comments a little bit more, then you will understand that there actually is an obstetric emergency happening in the home. Yeah. Are there home birth midwives around who might be able to comment? Yeah. It's interesting, Mabe's comment regarding if you're working in obstetric led environment can be inspiring, hopeful to see images like this. And that's definitely the case. And yeah, also Hazel just said, shoulder dystocia happens at home. Yeah. Mm hmm. It looks like I think if you've got trust in your provider as well, I think that makes a very big difference. Yeah. Absolutely. Let's have a look at some of our comments, if there's any severe that you think. Yeah, sure. So some people said, I think it's a little frightening. Looks like the midwife is pulling the baby and the baby is blue. We know that babies are also a little bit cyanotic when they were. So I believe that this was a positive outcome, though. I'm encouraging this year. Shoulder dystocia can be managed outside the hospital setting. Encouraging midwives of skilled professionals and birth should not be institutionalised due to fear. So yeah, strong comment. Yeah. And that is a very real possibility. And so long as the midwife is experienced enough, it can be managed. All right. So I'll move on to I think this is the last one before we can have some comments. Oh, here's someone who Tammy, homebound midwife. Shoulder dystocia is rare. OK. Had none. And say in positions that help shake baby out of the pelvis and then come back down quickly into a better position. Great. Oh, I'm loving all these comments. I'm going to go and look at these bodies and stuff. Thank you. All right. I'll move on to the last one. Yeah, this is our last one. Neff, do you want to talk about this one? Yeah. So this one is a twin home birth. So when we looked at the comments, a lot of people were actually a bit confused. And I guess this is another thing about images being framed in a certain way as well. But people were saying, you know, is this at hospital? Is this at home? Are they just having a nice bath together? Or, you know, are these babies actually being born in the water? So, yes, to give you a bit of context and the comment is father catching his own family. This is a this account is a bit iffy, but you do need to go and look for verification of a few things as well to make sure that it is correct. And that's definitely this birth happened in the bath. But a lot of comments, you know, were like, wow, amazing. You know, I don't find this confronting at all. You know, twin birth should should also be normal. And on the flip side, there were the kind of heightened comments about risks and things like that. But I think the biggest one that stood out and the comment that we have on the slide there is sorry, but not real. And it's a really short comment, but I think it's really powerful because if it means that people don't believe that, you know, there are those options out there, then can we keep things normal or do we go along that obstetric led route? I don't know. Yeah, I mean, when I saw that comment, I thought, I wonder if it is. And I did some research and I found the original source and it indeed was. And I guess this is also a new era of fake news. However, you'd hope that there wasn't an Instagram account where there was an agenda to push a type of birthing. There was a really interesting comment that stood out among the others there. Yeah, well, I mean, that's right. So we're being told to wrap up, but we can go to our last slide. But thanks very much for joining us. I don't know if we have time for comments, but I guess just to sum up a few points, you know, we especially with is a powerful storytelling tool and it's also sources of information for birthing women and as much as they're in control of their own bodies and their choices, they're also in control of the narratives that they construct around their birth. So I guess as midwives, you know, the biggest bigger advice I've been told by a big wife is just to meet the woman where she is in her journey and how can we do that and be aware of all the things? We can't we can't know everything, but we can certainly open our eyes to what's going on in the online community as well as our own. Can I say that? Thank you. Are there any questions? Thank you, Antoinette and Sophia. This is awesome, really, really awesome. Fortunately, our time is up and I know you've been responding to people's comments as they came in. So and then again, the links are shared in the notes. And I guess you can follow up with questions, writing to the emails that we have seen where they've done a great deal.